Fat jab makers bet on NHS to be role model for the world

Telegraph

3 days ago

Britain is too fat. One in four people is classed as obese and, on average, they will live nine years less than if they were a healthy weight. They are three times more likely to develop colon cancer and five times more likely to develop type 2 diabetes.
Such statistics are not just a crisis in national health, they are also an economic nightmare for the NHS.
'Obesity has doubled since the 1990s and costs our NHS £11bn a year, triple the budget for ambulance services,' Health Secretary Wes Streeting said last month. 'Unless we curb the rising tide of cost and demand, the NHS risks becoming unsustainable.'
It is a threat that the Government is taking seriously, with a new ambition to tackle the problem once and for all.
'We now have the science, technology, and knowledge to end the obesity epidemic, if we seize this opportunity,' Streeting says.
A crucial part of the plan is the wide rollout of weight-loss injections which, up until this point, have largely been reserved for those who can afford them.
The Government instead wants fat jabs to be available 'based on need and not the ability to pay' and is testing new approaches to speed up the rollout of obesity medicines.
Public health officials are not the only ones watching closely.
At Danish giant Novo Nordisk, which makes obesity jab Wegovy and diabetes drug Ozempic, which can be used off-label for weight loss, executives are eager to know what ministers' next step will be.
Sebnem Avsar Tuna, its UK chief, says that the Government's plans could prove a game-changer for Novo Nordisk, showing the benefits of these medicines to the world.
'I think there's a big opportunity for the UK to be a role model,' she says.
'We just need to speed up in terms of getting into the actions, so it's not just on paper ... This is what needs to be shown, at the population health scale, to the entire world: what could be the outcome in a real-world setting.'
Test case for the world
In other words, Britain could be the test case for the world. If Wegovy can dramatically improve Britain's health – and cut costs – then surely other countries will follow.
The Government says it is exploring whether it could bring in a new payment model for weight-loss treatments, so that it would pay pharmaceutical companies based on how well their drugs made the nation healthier.
For now, details over the Government's plans remain sparse. The fat jab plans are part of a wider obesity strategy, which also includes curbing calories in supermarkets and getting the country exercising.
Ministers have yet to publish a comprehensive strategy.
The pharmaceutical industry is not yet clear on which weight-loss drugs could be offered more broadly, nor how they will be rolled out to patients or whether weight limits guiding who can qualify for the jabs will be softened.
So far only Eli Lilly's skinny jab Mounjaro is offered on the NHS through GPs. Novo's obesity jab is currently just available through specialist weight management clinics on the public health service, although can be bought privately.
Still, both jabs have strict requirements over who is eligible. A person would need to have a BMI of over 40 – classing them as severely obese – as well as at least four of five specific health conditions, which include type 2 diabetes and sleep apnea, to qualify for a weight loss jab when seeking the treatment through a GP.
There are concerns that current limits means the drugs are too restricted.
'We should be doing it for people who are becoming obese,' says one government adviser. 'That way, we can get them down to something that looks close to a normal range and then they can go back to work and start paying taxes.'
Old habits die hard
However, there are concerns that public health officials may resist a broad roll-out of the fat jabs after years where obesity was viewed as a behavioural issue, not something to be treated with medicine.
'The problem is this is very contrary to the status quo in this field, which is: we think you should stop eating, and then you won't be as fat,' the adviser says.
There is a 'culture war within the health system between the old school public health doctors who say it's all about behavioural change, and the people who say, 'Hang on a minute, we haven't done so bad with statins, we should do the same with obesity''.
'Wes is probably more inclined to go for the latter view. The trouble is, Wes is not making the decisions. It's being made by a whole load of old-school doctors.'
Drug bosses are anxious to see any signs of progress. 'We just need to speed up in terms of getting it done,' says Avsar Tuna.
A speedy roll-out could provide not just a boost for Britain's health but also a shot in the arm for Novo Nordisk, which has been struggling in the US.
It has faced weaker demand for Wegovy after a boom in cheap replica fat jabs.
In May it blamed the copycat drugs – which were allowed by US regulators because of supply issues at Novo Nordisk – for forcing it to slash sales and profit forecasts. Lars Fruergaard Jørgensen was unexpectedly ousted as chief executive at the same time.
The arms race in weight loss
Regulators have since banned the cheap replicas. Still, it is facing a more existential threat in the form of rival Eli Lilly, amid growing uptake of the US company's Mounjaro weight-loss jab.
In a recent head-to-head trial, Mounjaro beat Novo's Wegovy for weight-loss. Barclays analyst Emily Field says she has heard anecdotally that patients prefer Mounjaro too.
'When you look at the side effects in terms of patients that discontinue the drug because they're not feeling well, the two drugs look very similar,' she says. 'But when you actually talk to doctors, they disagree with that. They say that patients just feel better on the Lilly drug.'
Novo Nordisk has been racing to develop new medicines to show it can compete, though investors are not entirely convinced.
Its share price is down more than 50pc over the past year. Field says the company was 'really hampered' by the fact it was hit by shortages last year.
Avsar Tuna says the company has enough capacity to meet demand. 'I can say that we don't have any supply challenges,' she says.
If the NHS were to rapidly step up orders, she believes Novo Nordisk could deliver.
'I think it's a positive problem to look at,' Avsar Tuna says. 'If the NHS really comes back and says, tomorrow, I want X number of products from you to be able to give it all to patients, that would be a good dream to have.'
Whether the call will come is another matter. Government advisers remain concerned that public health chiefs will try to stand in the way of a sweeping roll-out. 'If you ask me, they're in a bit of a muddle about these drugs,' says one insider.
Still, Streeting is clearly convinced that they are the answer to Britain's weight problems.
'This Government is determined to bring revolutionary modern treatments to everyone who needs them, not just those who can afford to pay,' the Health Secretary said last month.
'There can be no doubt that these drugs will support our shift from sickness to prevention and be a game-changer for millions.'